Outline

Objective: Meningiomas frequently extend into the optic canal and cause progressive visual impairment. Surgical decompression of the optic nerve is the only option to preserve visual function. Depending on the invaded structures, optic nerve decompression can be part of a complete tumor removal or the main surgical intention in terms of local debulking.

Methods: From 2006 to 2011 we operated 46 consecutive patients on meningiomas of the cavernous sinus, sphenoid wing, anterior clinoid process, and tuberculum sellae invading the optic canal. Resection included bony decompression of the optic nerve via anterior clinoidectomy. Extent of resection was determined intraoperative as well as by postoperative MR imaging. Moreover, pre- and postoperative visual functions were evaluated by an ophthalmologist.

Results: Forty-six patients (34 female, 12 male) were enrolled with a mean age of 61.1Â±12.5 years. Tumor size was 3.1Â±1.2 cm and 2 patients had undergone preoperative radiation therapy. Gross-total resection was achieved in 29 (63%) and partial resection in 17 patients (37%). We observed no surgery-related death. The main presenting symptom was visual impairment in 63.2% of patients while 26.8% had no disturbed vision. Changes in vision were significantly related to the preoperative visual function: in all patients with normal preoperative vision it remained unchanged while in patients with impaired vision, surgery caused an improvement in 70% and an aggravation in 10% of patients while 20% remained unchanged (p<0.0001).

Conclusions: Optic nerve compression and impairment by meningiomas is frequent and can be a prominent factor in surgical indication and treatment strategy. Surgical management of these tumors including anterior clinoidectomy is crucial to achieve and maintain the optimal visual function in our patients.